Organization
CREATIVE COUNSELING SERVICES, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY PAUL PENNINGTON LCSW (LICENSED CLINICAL SOCIAL WORKER)
(573) 714-4076
Entity
Organization
Contact information
Practice address
173 LISA AVE, POPLAR BLUFF, MO 63901-9093
(573) 714-4076
(573) 785-6813
Mailing address
173 LISA AVE, POPLAR BLUFF, MO 63901-9093
(573) 714-4076
(573) 785-6813
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2004024505
MO
Other
Enumeration date
07/09/2006
Last updated
08/22/2020
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